Testing the moderating role of in-person and virtual social interactions among university students on the relationship between loneliness and anxiety or depressive symptoms

Testing the moderating role of in-person and virtual social interactions among university students on the relationship between loneliness and anxiety or depressive symptoms | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Testing the moderating role of in-person and virtual social interactions among university students on the relationship between loneliness and anxiety or depressive symptoms Ilaria Riboldi, Cristina Crocamo, Chiara Alessandra Capogrosso, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6914480/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background: The transition to university can amplify students’ social isolation, leading to mental distress. In particular, loneliness could play a key role in the onset of anxiety and depressive symptoms. Different patterns of students’ social interactions, both in-person and online, may add complexity to the relationship between loneliness and mental health problems. Our study aimed to evaluatethe moderating role of both in-person and virtual social connectedness on the relationship between loneliness and anxiety or depressive symptoms. Method: Data were from the CAMPUS study (0058642/21; FHMS 20-21 157), a survey on university students’ mental health in Italy and the United Kingdom (UK). An ordered logistic regression was carried out to test the potential moderating effect of social media use and the frequency of in-person interactions on the relationship between loneliness (UCLA), anxiety (GAD-7), and depressive symptoms (PHQ-9). Results: A significant positive association between perceived loneliness and both anxiety (p<0.001) and depressive symptoms (p<0.001) was found. However, in-person interactions significantly moderated this relationship for both anxiety, in a bidirectional way depending on the level of loneliness (p<0.001), and depressive symptoms (coeff.=-0.25, 95%CI -0.45;-0.05, p=0.016). Furthermore, social media use significantly influenced the relationship between loneliness and depressive symptoms (coeff.=0.21, 95%CI 0.12;0.31, p<0.001), but not the relationship between loneliness and anxiety symptoms (p=0.47). Conclusions: Along with the association between loneliness and anxiety or depressive symptoms, our findings highlight the key moderating role of both virtual and in-person social interactions, which may be targeted by tailored support, ultimately improving anxiety and depressive symptoms among university students. loneliness mental health social connectedness social media university students Figures Figure 1 1. Background The university experience, while often seen as a time of growth and opportunity, can also amplify students’ sense of isolation, leading to psychological and mental distress [ 1 ]. As a result, common mental health issues, namely anxiety and depressive symptoms, have risen both in incidence and severity among university students [ 1 ]. Recent evidence suggests that geographical relocation and social adjustments, with difficulties in building new social connections, could exacerbate feelings of loneliness [ 2 ]. As a matter of fact, loneliness arises through the interplay of predisposing and precipitating individual factors, including challenges of adapting to an unfamiliar academic and cultural environment [ 3 ]. While young adults are particularly vulnerable to the adverse effects of loneliness [ 4 ], evidence consistently shows that positive interpersonal interactions, supportive relationships, and a strong sense of belonging are associated with reduced levels of stress, anxiety, and depressive symptoms [ 5 ]. These findings highlight the critical role of in-person social connectedness as a key determinant of well-being, particularly within university settings [ 6 ]. However, in recent years, also the rapid expansion of digital communication, mainly social media, has significantly reshaped social interactions, with both opportunities and challenges for students’ psychological well-being and academic performance [ 7 ]. Social media, broadly defined as websites and applications that enable users to create and share content or to participate in social networking, can foster students’ sense of belonging by facilitating connections with pre-existing support networks, and enabling new friendships [ 8 , 9 ]. In addition, they provide a suitable space for self-disclosure and help-seeking within virtual communities [ 8 , 10 ]. However, research has shown that spending more time online is associated with self-isolation, and the persistent comparison with peers through social content can exacerbate feelings of exclusion and inadequacy, leading to anxiety and depressive symptoms [ 11 – 13 ]. Indeed, the psychological effects of social media seem to be influenced by the patterns of user engagement, with findings supporting a wide range of both positive and negative impacts on feelings of loneliness [ 14 , 15 ]. Although loneliness has been consistently associated with anxiety and depression, the potential mediating role of both online and in-person social connectedness on this relationship has not been fully explored yet [ 16 , 17 ]. In particular, it can be argued that both virtual and in-person social interactions could partially mediate the relationship between loneliness and students’ mental health and might represent potential targets for intervention. Thus, benefiting from data of cross-sectional study using a large and representative sample of university students from Italy and the UK, we tested the hypotheses that: (i) loneliness, social media use, and the frequency of in-person social interactions would be associated with anxiety and depressive symptoms; and (ii) the relationship between loneliness and these symptoms would be at least partially moderated by patterns of social media use and face-to-face interactions. 2. Materials and Methods 2.1. Study design and setting This study followed the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) checklist [ 18 ]. Data were from the second wave of the “Caring and Assessing Mental health of student Populations at Unimib and uniSurrey (CAMPUS) study”, a large survey, longitudinally assessing the mental health of university students enrolled at the University of Milano-Bicocca (Unimib, Italy) and the University of Surrey (UoS, UK). The second wave was selected since it offered the most recent and comprehensive dataset available at the time of analysis. An online survey was delivered by e-mail to students between October and November 2022. The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2025. All procedures involving human subjects were approved by the Ethics Committees of the University of Milano-Bicocca (registration number: 0058642/21) and of the University of Surrey (registration number: FHMS 20–21 157). Students older than 18 provided their informed consent online. They could complete the survey in a private setting and quit at any time. The online platform (Qualtrics) anonymously tracked both complete and partial responses. 2.2. Measures An extensive battery of instruments was used to gather information on both individual characteristics and psychometric measures, though only those relevant to this study are presented here. 2.2.1. Participant Information We collected information on age, gender, living conditions, and employment status. Data on the degree course, the years of study completed, as well as on the international background were also gathered. In-person social connectedness was assessed based on the frequency of interactions —categorized as daily/weekly versus monthly or less frequent — with relatives, friends, and classmates. Virtual social interactions were assessed based on the number of hours per day spent on social media and the type of platforms used. 2.2.2. Clinical Measures Self-report psychometric measures included the 7-item General Anxiety Disorder scale (GAD-7), the 9-item Patient Health Questionnaire (PHQ-9), and the 7-item Insomnia Severity Index (ISI). The 7-item General Anxiety Disorder scale (GAD-7) was used to assess symptoms of generalized anxiety experienced in the previous two weeks. Response options include “never”, “some days”, “more than half the days”, and “almost every day”, with scores of 0, 1, 2 and 3, respectively, with the relevant total score for the seven items ranging from 0 to 21, and cut-offs as follows: 0–4 minimal, 5–9 mild, 10–14 moderate, and 15–21 severe anxiety [ 19 ]. As far as depressive symptoms assessment, we used the 9-item Patient Health Questionnaire (PHQ-9) [ 20 ], the self-administered version of the Primary Care Evaluation of Mental Disorders (PRIME-MD) [ 21 ]. The PHQ-9 enables screening, diagnosis, and severity assessment through nine items that reflect the symptoms of major depression according to DSM-IV over the previous two weeks. Possible answers include “never”, “several days”, “more than half the days”, and “nearly every day” and each item is rated from 0 (“never”) to 3 (“nearly every day”). The total score ranges from 0 to 27, according to these cut-offs: 5–9 mild, 10–14 moderate, 15–19 moderately severe, and ≥ 20 severe depressive symptoms [ 20 ]. The Insomnia Severity Index (ISI) is a self-report questionnaire designed to assess the severity of insomnia. It consists of seven items, each rated on a 5-point Likert scale, with total scores ranging from 0 to 28 and cut-offs as follows: 8–14 subthreshold, 15–21 moderate, and 22–28 severe insomnia [ 22 ]. 2.2.3. Loneliness Perceived loneliness was assessed through the UCLA Loneliness Scale (Version 3), which consists of 20 items, each rated on a 4-point Likert scale, covering various aspects of social and emotional loneliness, according to these cut-offs: 20–34 low, 35–49 moderate, 50–64 moderately high, and 65–80 high degree of loneliness [ 23 ]. 2.3. Statistics Statistical analyses were run using Stata (version 18, StataCorp. 2021. Stata Statistical Software, College Station, TX, USA). After performing validity and consistency checks of collected data, descriptive analyses were carried out to summarize characteristics of survey participants. In addition, we dealt with missing data issues, verifying that information on anxiety symptoms was not available when participants were early quitters (i.e., unanswered items > 30%). We compared students who completed the survey to early quitters in order to identify characteristics potentially accounting for differences in the likelihood to complete the survey. Therefore, assuming that non-response depends at most on covariates, we ruled out a missing not at random (MNAR) condition. Standard statistics were provided for both continuous and categorical variables, stratifying by UCLA Loneliness scale cut-offs. Potential differences in perceived loneliness were thus assessed across individual characteristics by both running Pearson’s chi-square and Fisher’s exact tests for categorical variables and performing parametric (e.g., Student’s t test, analysis of variance) or non-parametric (e.g., Wilcoxon-Mann-Whitney test) analyses for continuous variables according to potential deviations of relevant assumptions (e.g., normally distributed residuals). Then, we carried out an ordered logistic regression and tested the potential moderating impact of social media use and the frequency of in-person social contacts on the interaction of loneliness categorized according to UCLA Loneliness Scale cut-offs (independent variable) and anxiety and depressive symptoms (dependent variable). Therefore, main effects and interaction terms were estimated. Each factor was entered in separate models to assess the individual impact on this relationship, and the potential effect between loneliness, anxiety and depressive symptoms was estimated considering time on social media and the frequency of in-person social interactions strata. All models were adjusted for gender, age, and insomnia symptoms, potentially accounting for differences. In addition, we allowed for intragroup correlation, considering that observations may not be independent within site (Italy vs. UK) groups. Regression coefficients with 95% Confidence Intervals (95%CI) and Standard Errors (SE) were reported. Statistical significance was set at a p-value of 0.05. 3. Results 3.1. Sample Characteristics The online survey was delivered to all university students older than 18, gathering a total of 2,979 responses. As a whole, 69% of the sample reported information on anxiety symptoms. Therefore, the final sample comprised 2,055 undergraduate students from Italy and the UK, including (21.5%) men and (75.4%) women with a mean age (standard deviation, SD) of 22.77 (5.21) years. Most students (71.2%) were attending the first two years of their academic career, mainly from Psychosocial Sciences (703/34.2%), Medical Sciences (517/25.2%), and Applied/Natural Sciences (456/22.2%) programmes. Overall, 1,038 participants (50.5%) reported spending between one and three hours per day on social media. In addition, half of the sample used more than one social platform, with Instagram® being the most popular (1,620/78.9%), followed by TikTok® (768/37.4%). Finally, 1,410 (68.6%) students reported having near-daily in-person interactions with relatives and 646 (31.4%) with friends. As compared to students who quitted the survey early and did not report information on anxiety symptoms, but only sociodemographic data (N = 369), survey completers (N = 2,055) were more likely to be younger [22.76 (SD = 5.21) vs. 23.80 (SD = 5.40); p < 0.001], and to be from the UK (34.21% vs. 20.33%; p < 0.001). Descriptive statistics for the overall sample of students who completed the survey are presented in Table 1 , with country-specific data detailed in Supplementary Table 1 . Table 1 Sociodemographic and clinical characteristics by level of perceived loneliness assessed by UCLA Loneliness Scale (Version 3). Characteristics Overall sample UCLA** p-value* N = 2,055 Low Moderate N (%) or Mean (SD) Moderately high High N (%) or Mean (SD) N (%) or Mean (SD) N (%) or Mean (SD) N (%) or Mean (SD) Gender Women Men 1,550 (75.4%) 442 (21.5%) 219 (14.2%) 55 (12.4%) 494 (31.9%) 134 (30.3%) 533 (34.4%) 170 (38.5%) 136 (8.8%) 38 (8.6%) p = 0.46 Age , yrs. 22.77 (5.21) 23.75 (6.22) 22.99 (5.81) 22.45 (4.37) 22.16 (3.57) p = 0.08 Years of study First 664 (32.3%) 85 (12.8%) 182 (27.4%) 257 (38.7%) 69 (10.4%) p = 0.002 Second 634 (38.9%) 83 (13.1%) 228 (36%) 204 (32.2%) 58 (9.2%) Third 445 (21.7%) 48 (10.8%) 144 (32.4%) 163 (36.6%) 39 (8.8%) Fourth 119 (5.8%) 22 (18.5%) 38 (32%) 35 (29.4%) 11 (9.2%) Fifth - Sixth 126 (6.1%) 26 (20.6%) 35 (27.8%) 49 (38.9%) 8 (6.3%) Degree Programme Area Applied/Natural Sciences 1 456 (22.2%) 51 (11.2%) 125 (27.4%) 175 (38.4%) 59 (12.9%) p = 0.002 Economic/Legal Sciences 2 343 (16.7%) 40 (11.7%) 109 (31.8%) 118 (34.4%) 23 (6.7%) Medical Sciences 3 517 (25.2%) 83 (16.1%) 152 (29.4%) 187 (36.17%) 41 (7.9%) Psychosocial Sciences 4 703 (34.2%) 101 (14.4%) 245 (34.9%) 238 (33.9%) 60 (8.53%) International student 103 (5.0%) 12 (11.7%) 34 (33.0%) 36 (35.0%) 9 (8.8%) p = 0.94 Out-of-town student 686 (33.4%) 92 (13.4%) 225(32.8%) 244 (35.6%) 65 (9.5%) p = 0.92 Employment Non-worker Part-time or full-time worker 683 (33.2%) 1,332 (64.8%) 87 (12.7%) 189 (14.2%) 208 (30.5%) 425 (32.0%) 246 (36.0%) 465 (35.0%) 70 (10.3%) 115 (8.6%) p = 0.49 Marital status Single 1,047 (51.0%) 108 (10.32%) 309 (29.5%) 397 (37.9%) 114 (10.9%) p < 0.001 In a committed relationship 945 (46.0%) 162 (17.1%) 320 (33.9%) 309 (32.7%) 63 (6.70%) Accommodation With family of origin 1,071 (52.1%) 133 (12.4%) 344 (32.1%) 389 (36.3%) 102 (9.5%) p < 0.001 On campus 302 (14.7%) 43 (14.2%) 86 (28.5%) 101 (33.4%) 31 (10.3%) With roommates outside campus 375 (18.3%) 50 (13.3%) 131(35.0%) 134 (35.7%) 20 (5.3%) With partner 164 (8%) 34 (20.7%) 48 (29.3%) 55 (33.6%) 9 (5.5%) Alone 103 (5.0%) 11 (10.7%) 25 (24.3%) 38 (36.9%) 20 (19.4%) On track with exams 1,298 (63.2%) 206 (15.9%) 438 (33.7%) 427 (32.9%) 96 (7.4%) p < 0.001 Social interactions – family Daily/more time a week 1,410 (68.6%) 182 (13%) 436 (30.9%) 515 (36.5%) 131 (9.3%) p = 0.12 Weekly 251 (12.2%) 49 (19.5%) 77 (30.7%) 79 (31.5%) 21 (8.4%) Monthly or less 349 (17.0%) 44 (12.6%) 119 (34.1%) 117 (33.5%) 31 (8.9%) Social interactions – partner Daily/more time a week 616 (30.0%) 104 (16.9%) 208 (33.8%) 206 (33.4%) 38 (6.2%) p = 0.033 Weekly 152 (7.4%) 27 (17.8%) 55 (36.2%) 37 (24.3%) 20 (13.2%) Monthly or less 287 (14%) 50 (17.4%) 87 (30.3%) 101 (35.2%) 18 (6.3%) Social interactions – friends Daily/more time a week 646 (31.4%) 110 (17.0%) 221 (34.2%) 203 (31.4%) 49 (7.6%) p < 0.001 Weekly 689 (33.5%) 69 (10.0%) 222 (32.2%) 268 (38.9%) 59 (8.6%) Monthly or less 693 (33.7%) 99 (14.3%) 198 (28.6%) 249 (35.9%) 72 (10.4%) Social interactions – classmates Daily/more time a week 901 (43.8%) 122 (13.5%) 306 (34%) 311 (34.5%) 71 (7.9%) p = 0.39 Weekly 233 (11.3%) 28 (12%) 79 (33.9%) 80 (34.3%) 25 (10.7%) Monthly or less 801 (39.0%) 118 (14.7%) 134 (16.7%) 286 (35.7%) 72 (9.0%) Time spent on social media < 1 hrs. 262 (12.8%) 42 (16.0%) 89 (34.0%) 80 (30.5%) 29 (11.1%) p = 0.005 From 1 to 3 hrs. 1,038 (50.5%) 160 (15.4%) 324 (32.2%) 364 (35.1%) 82 (7.9%) From 3 to 5 hrs. 552 (26.9%) 58 (10.5%) 180 (32.6%) 195 (35.3%) 50 (9.1%) > 5 hrs. 180 (8.8%) 17 (9.4%) 45 (25.0%) 82 (45.6%) 24 (13.3%) Number of social media platforms 1 997 (48.2%) 132 (13.2%) 313 (31.4%) 351 (35.2%) 97 (9.7%) p = 0.79 2 798 (38.8%) 114 (14.3%) 260 (32.6%) 275 (34.5%) 66 (8.3%) 3 227 (11.0%) 31 (13.7%) 61 (26.7%) 90 (39.7%) 21 (9.3%) ≥ 4 33 (1.6%) 2 (6.1%) 11 (33.3%) 13 (39.4%) 3 (9.1%) Anxiety symptoms (GAD-7) 9.38 (5.32) 5.77 (4.29) 8.07 (4.50) 10.79 (5.16) 13.76 (9.38) p < 0.001 Depressive symptoms (PHQ-9) 9.83 (6.21) 5.05 (4.23) 7.11 (5.04) 11.64 (5.75) 16.24 (6.10) p < 0.001 Insomnia symptoms (ISI) 9.06 (5.21) 6.35 (4.13) 8.36 (4.78) 10.05 (5.22) 11.66 (5.77) p < 0.001 * Statistically significant differences between groups defined by the UCLA Loneliness Scale (Version 3) cut-offs (p < 0.05). ** Data for the UCLA Loneliness Scale (Version 3) was available for 1,841 (90%) participants. Missing values are not reported in the table. SD: Standard deviation. 1 Applied/Natural Sciences: Biochemistry; Biology; Biomedical Engineering; Biomedical Sciences; Computer Sciences; Geology; Maths. 2 Economic/Legal Sciences: Economics; Hospitality and Tourism; Law; Politics. 3 Medical sciences: Medicine and Surgery; Nursing; Nutrition; Paramedics; Veterinary Medicine. 4 Psychosocial sciences: Education Sciences; Intercultural Communication; Psychology; Sociology 3.2. Clinical assessment, in-person social interactions and social media use The mean UCLA loneliness score for the overall sample was 48.78 (SD = 12.31). Compared to individuals with low loneliness, those with moderate loneliness reported significantly higher anxiety (coeff.=1.03, 95%CI 0.79; 1.26, p < 0.001) and depressive symptoms (coeff.=1.25, 95%CI 0.83; 1.66, p < 0.001). This association was even more marked for individuals with moderately high to high loneliness levels (anxiety: coeff.=2.15, 95%CI 2.03; 2.28, p < 0.001; depressive symptoms: coeff.=2.65, 95%CI 2.29; 3.01, p < 0.001), as compared to those with lower total scores at UCLA. In addition, students who reported interacting with friends almost daily had a mean UCLA score of 46.97 (SD = 12.32), significantly lower (p < 0.001) as compared with those with less frequent social connections [49.16 (SD = 12.80)]. Conversely, participants who used social media for less than 3 hours per day reported a mean UCLA score of 47.96 (SD = 12.43), whereas those daily using them for 3 or more hours had a higher mean score [50.22 (SD = 11.96)] (p = 0.005). The mean score for anxiety symptoms, as measured by the GAD-7, was 9.38 (SD = 5.32). Students who more frequently interacted with friends reported a higher mean GAD-7 score (mean = 9.62, SD = 5.21) as compared to the comparison group (mean = 9.04, SD = 5.79) (p < 0.001). Furthermore, students who reported daily use of social media for less than 3 hours had a significantly lower mean GAD-7 score (mean = 8.91, SD = 5.09) compared to those who used them ≥ 3h/day (mean = 10.11, SD = 5.62) (p < 0.001). The average score for depressive symptoms, as assessed by PHQ-9, was 9.83 (SD = 6.21). Participants who spent ≥ 3h/day on social media reported higher levels of depressive symptoms (mean = 11.30, SD = 6.24) compared to those with less frequent use (mean = 9.01, SD = 6.03) (p < 0.001). Relevant associations for the overall sample and by UCLA levels are presented in Table 1 . 3.2.1 Effect of in-person and virtual social interactions on the relationship between loneliness and anxiety symptoms. Building on the observation that the estimated effects of loneliness on GAD-7 and PHQ-9 total scores varied according to the frequency of contact with friends and the amount of time spent on social media, we explored potential interaction effects between these variables. Therefore, after controlling for gender, age, and insomnia symptoms, we tested whether frequency of interactions with friends and social media use would moderate the relationship between loneliness (categorized as moderately and moderately/high vs. low for analytical purposes) and anxiety symptoms. (Table 2 a) A statistically significant main effect of perceived loneliness on anxiety symptoms was observed (moderate loneliness: coeff.=0.84, 95%CI 0.81; 0.88, p < 0.001; moderately high/high loneliness: coeff.=2.20, 95%CI 1.90, 2.49, p < 0.001). Moreover, a significant effect of in-person interactions on the relationship between loneliness and anxiety symptoms was found. Specifically, among individuals reporting moderate loneliness, more frequent social interaction with friends was significantly associated with higher GAD-7 scores (coeff.=0.21, 95%CI 0.15; 0.27, p < 0.001). On the contrary, students with moderately high/high UCLA loneliness scores who interacted with friends multiple times a week or daily showed a significant association with lower level of anxiety (coeff.=-0.36, 95%CI -0.44; -0.27, p < 0.001). No significant contribution of social media use to the model was found (p = 0.47). The moderation models are shown in Fig. 1 a. Table 2 a/2b. Ordered logistic regression assessing the influence of in-person social interactions and social media use on the relationship between loneliness and anxiety and depressive symptoms. * 2a. Anxiety symptoms (GAD-7) Coefficient Standard error 95%CI p-value Loneliness (UCLA) a moderate 0.84 0.02 0.81; 0.88 p < 0.001 moderately-high/high 2.20 0.15 1.90; 2.49 p < 0.001 In-person interactions b weekly 0.54 0.11 0.32; 0.75 p < 0.001 daily/multiple times a week 0.65 0.09 0.49; 0.82 p < 0.001 Social media use c ≥ 3h/day 0.03 0.36 -0.67; 0.73 p = 0.93 Age -0.02 0.00 -0.03; -0.02 p < 0.001 Female sex 0.75 0.02 0.70; 0.79 p < 0.001 ISI total score 0.12 0.01 0.10; 0.14 p < 0.001 Loneliness (UCLA) a × in-person interactions b moderate × weekly -0.25 0.48 -0.35; -0.16 p < 0.001 moderate × daily/multiple times a week 0.21 0.03 0.15, 0.27 p < 0.001 moderately-high/high × weekly -0.50 0.03 -0.56; -0.44 p < 0.001 moderately-high/high × daily/multiple times a week -0.36 0.04 -0.44; -0.27 p < 0.001 2b. Depressive symptoms (PHQ-9) Coefficient Standard error 95%CI p-value Loneliness (UCLA) a moderate 1.00 0.08 0.85; 1.15 p < 0.001 moderately-high/high 2.40 0.12 2.16, 2.63 p < 0.001 In-person interactions b weekly 0.08 0.06 0.12; 0.31 p = 0.18 daily/multiple times a week 0.12 0.21 0.12; 0.20 p = 0.56 Social media use c ≥ 3h/day 0.17 0.15 -0.13; -0.47 p = 0.27 Age -0.04 0.00 -0.05; -0.03 p < 0.001 Female sex 0.43 0.01 0.40; 0.45 p < 0.001 ISI total score 0.21 0.01 0.20; 0.22 p < 0.001 Loneliness (UCLA) a × in-person interactions b moderate × weekly -0.07 0.11 -0.29; 0.14 p = 0.50 moderate × daily/multiple times a week -0.06 0.22 -0.49; 0.38 p = 0.79 moderately-high/high × weekly -0.25 0.10 -0.45; -0.05 p = 0.016 moderately-high/high × daily/multiple times a week -0.19 0.27 -0.07; 0.33 p = 0.47 Loneliness (UCLA) a × social media use c moderate × ≥3h/day 0.21 0.05 0.12; 0.31 p < 0.001 moderately-high/ high × ≥3h/day 0.16 0.02 0.12; 0.20 p < 0.001 N = 1,793 3.2.2 Effect of in-person and virtual social interactions on the relationship between loneliness and depressive symptoms. Controlling for the same variables, we tested the moderating effect of in-person and online social interactions on the relationship between loneliness and depressive symptoms ( Table 2b ). Based on UCLA scores categorized as moderately and moderately/high vs. low for analytical purposes, a statistically significant effect of loneliness on the likelihood of higher PHQ-9 scores was detected (moderate loneliness: coeff.=1.25, 95%CI 0.83; 1.66, p<0.001; moderately high/high loneliness: coeff.=2.65, 95%CI 2.29; 3.01, p<0.001). In addition, in-person interactions showed a potential mediating role on the relationship between loneliness and depressive symptoms. Specifically, among individuals reporting moderately high/high loneliness, more frequent social interactions with friends were significantly associated with lower PHQ-9 scores (coeff.=-0.25; 95%CI -0.45; -0.05, p=0.016). Finally, a significant effect of the use of social media on the relationship between loneliness and depressive symptoms was found. Indeed, among individuals reporting moderate loneliness, more intense use of social media was significantly associated with higher PHQ-9 scores (coeff.=0.21, 95%CI 0.12; 0.31, p<0.001). Similarly, students with moderately high/high UCLA loneliness scores who use social media ≥3 hours/day showed a significant association with higher PHQ-scores (coeff.=0.16, 95%CI 0.12; 0.20, p<0.001).The moderation models are shown in Figure 1b . 4. Discussion To our knowledge, this is the first study investigating whether in-person or virtual social interactions can influence the relationship between loneliness and anxiety and depressive symptoms among university students. We consistently observed distinct associations between loneliness, in-person and online social interactions, and symptoms of anxiety and depression. In addition, both in-person and online social connections exerted a moderating effect on the relationship between loneliness and anxiety and depressive symptoms. Our findings are consistent with prior research showing a positive association between loneliness and both anxiety and depressive symptoms from both cross-sectional[16,17] and longitudinal research[24].Evidence also suggests a bidirectional relationship, where loneliness and depression mutually reinforce one another over time[24]. Similarly, anxiety has been found to predict future experiences of loneliness across age groups, following a reciprocal trajectory[4,25]. Loneliness has also been identified as a mediator in the relationship between anxiety and depression and is closely linked to social anxiety, both in youth and older adults[26].Shared features, such as social withdrawal, negative social cognition, impaired interpersonal functioning, and reduced quality of social interactions, may underlie and intensify the experience of loneliness [25]. Moreover, previous research has shown that supportive relationships and positive in-person interactions are associated with lower levels of loneliness in young adults [5,27], thus reinforcing the importance of social connectedness for students’ well-being [6]. Although anxiety is often linked to social withdrawal[4,5], some individuals with higher levels of generalized anxiety may actually seek out more frequent social interactions with peers as a coping mechanism or a strategy for emotional regulation[28]. In this light, social buffering may reflect an adaptive or compensatory behaviour in response to elevated anxiety levels, as well as a desire for reassurance, validation, or distraction from anxious thoughts[29,30]. On the contrary, a greater number of superficial relationships may heighten psychological distress by intensifying feelings of exclusion and inadequacy, ultimately contributing to increased anxiety [11,12,27]. Similarly, the impact of social media on mental health appears to be multifactorial, with excessive use or passive consumption potentially linked to increased feelings of isolation, unworthiness, and psychological distress[14,15,31].However, our study also reveals a partial moderating effect of in-person social interactions on the relationship between loneliness and both anxiety and depressive symptoms, as well as a partial moderating role of social media use in the relationship between UCLA scores and depressive symptoms. Notably, students with moderate levels of loneliness who engaged in frequent face-to-face interactions reported higher anxiety. Conversely, among students experiencing higher loneliness, frequent in-person interactions were associated with lower depressive symptoms and anxiety scores, suggesting a potential protective effect. This complexity underscores the importance of the quality rather than just the frequency of social contacts[32].The university environment, with its social demands, performance pressures, and need for integration, can heighten anxiety in vulnerable students, potentially creating a feedback loop in which social efforts increase psychological distress[33].This suggests that the impact of social interactions on mental health may depend on a student’s baseline level of loneliness and the specific features of social relationships [2,34]. Consistently, our results show that more frequent in-person contact can mitigate depressive symptoms in highly lonely students, highlighting the importance of emotional support and meaningful interpersonal exchanges in reducing psychological distress [5]. Indeed, evidence consistently shows that positive interpersonal interactions, supportive relationships, and a strong sense of belonging are associated with reduced levels of stress and depressive symptoms[5]. In contrast, we found that more frequent online interactions were associated with higher depression levels in students experiencing both moderate and high levels of loneliness. Several mechanisms may underlie this pattern [35]. First, increased social media use may displace real-life interactions, exacerbating pre-existing loneliness[35].The nature of online engagement could also play a crucial role, since the association between loneliness and poor mental health outcomes seem to be stronger in individuals with more frequent social media engagement[36].For students already feeling lonely, virtual interactions may fail to provide meaningful connection and instead worsen psychological vulnerability, creating a negative cycle where increased social media use deepens isolation and distress [11,12]. Superficial exchanges, or even negative experiences such as cyberbullying, may further compound feelings of isolation[11,12]. Understanding the role of cultural and lifestyle differences among students is also essential in interpreting our findings. For instance, UK students often live on campus or in shared accommodation [37],which may enhance peer interaction but also introduce new responsibilities and stressors linked to poorer mental health[38].Limited family contact, increased autonomy, and different lifestyle habits can contribute to elevated rates of depressive symptoms[39]. On the other hand, communal living may foster social engagement with peers[40].In contrast, most Italian students reside with their families[41], which may limit peer bonding opportunities and contribute to higher levels of social isolation and anxiety[5,34]. Overall, our findings highlight that the transition to university is a complex, multidimensional process that extends beyond academic adaptation to include crucial social components. Institutional support, such as orientation programs, peer mentoring, and community-building initiatives, plays a key role in facilitating this transition[42].Given the strong interplay between loneliness, social interaction, and mental health, interventions should focus on fostering social connectedness as a core element in both the prevention of loneliness and the promotion of mental well-being[43]. Creating opportunities for meaningful in-person interactions and group cohesion is just as important as encouraging a mindful and balanced approach to online engagement[44]. . In this context, social skills counselling may be especially beneficial for students experiencing loneliness, equipping them with tools to build and maintain supportive relationships[42,45]. Likewise, mental health interventions in the digital age should promote balanced use of online platforms, encourage critical consumption of digital content, and facilitate emotionally meaningful virtual interactions to counteract the potential negative effects of social media on well-being[8,44]. Limitations Our findings should be interpreted with caution considering some methodological limitations. First, the cross-sectional nature of the study does not allow us to draw conclusions on causal relationships between perceived loneliness, the dependent variables and any moderating factors. Consistently, different directional paths might underlie these relationships. Secondly, in-person and virtual social interactions were evaluated using approximate proxy measures, based on self-reported frequency of interactions with family members, peers, and classmates, as well as levels of engagement with social media platforms. We therefore only investigated the quantity, but not the quality, of social interactions. Future studies should incorporate more refined measures, such as assessments of social support, relationship quality, and the specific types of online and offline interactions, to provide a richer understanding of their impact on loneliness. Third, since clinical domains were measured by brief screening scales, future research would benefit from more comprehensive and structured diagnostic reporting of clinical conditions, in order to reduce recall bias and/or under-reporting, as well as potential misclassification. Furthermore, our methodology, reliant on an online survey for clinical data collection, inherently presents various limitations, notably concerning sampling issues [46]. Similarly, the selected participants may not entirely reflect the broader university student population. They are likely to be individuals already interested in mental health issues, potentially involving a selection bias. However, the survey was conducted within a private household setting, which has been shown to mitigate under-reporting and bias, facilitated by perceived privacy and anonymity, thereby addressing potential stigmatization or embarrassment [47]. 5. Conclusions Our study confirms the well-established link between perceived loneliness and anxiety and depressive symptoms. In-person social connectedness seems a significant mediator for both these outcomes among university students, while social media use seems to play a significant role in the relationship between loneliness and depressive symptoms. Interventions aimed at enhancing both the quantity and quality of in-person and virtual social interactions may be beneficial for students experiencing loneliness and associated clinical conditions. Abbreviations UK United Kingdom Unimib University of Milano-Bicocca UoS University of Surrey GAD-7 Generalized Anxiety Disorder scale-7 PHQ-9 Patient Health Questionnaire-9 ISI Insomnia Severity Index UCLA Ucla Loneliness Scale (Version 3) SD Standard Deviation. Declarations Ethics Approval The study was conducted in accordance with the Declaration of Helsinki, and approved by the Ethics Committee of University of Milano-Bicocca (protocol code 0058642/21; 19 March 2021) and of the University of Surrey (registration number: FHMS 20-21 157; 21 July 2021). Consent to participate Informed consent was obtained from all subjects involved in the study. Consent for Publication Not applicable. Availability of Data and Materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing Interests The authors declare that they have no competing interests. Funding This research received no specific grant from any funding agency, commercial or not-for-profit sectors. Authors’ contributions Conceptualization, I.R., C.C.; Methodology, I.R., C.C.; Validation, I.R., C.C.; Formal Analysis, I.R., C.C.; Investigation, I.R., C.A.C.; Resources, I.R., C.T. and J.A; Data Curation, I.R., C.A.C.; Writing—Original Draft Preparation, I.R.; Writing—Review & Editing, I.R., C.C., G.C., and F.B. Visualization, C.C., F.B. and G.C.; Supervision, C.T., J.A. and G.C.; Project Administration, C.T., J.A. and G.C. All authors have read and agreed to the published version of the manuscript. Acknowledgements We thank all the students who took part in the survey. We also thank the University Steering Committee for supporting and promoting the project, as well as the Programmes' Leaders from UoS, and the students' representatives from Unimib and UoS. 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Supplementary Files SupplementaryS1.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 21 Jul, 2025 Reviewers agreed at journal 15 Jul, 2025 Reviewers invited by journal 15 Jul, 2025 Editor invited by journal 23 Jun, 2025 Editor assigned by journal 18 Jun, 2025 Submission checks completed at journal 18 Jun, 2025 First submitted to journal 17 Jun, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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Background","content":"\u003cp\u003eThe university experience, while often seen as a time of growth and opportunity, can also amplify students\u0026rsquo; sense of isolation, leading to psychological and mental distress [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. As a result, common mental health issues, namely anxiety and depressive symptoms, have risen both in incidence and severity among university students [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Recent evidence suggests that geographical relocation and social adjustments, with difficulties in building new social connections, could exacerbate feelings of loneliness [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. As a matter of fact, loneliness arises through the interplay of predisposing and precipitating individual factors, including challenges of adapting to an unfamiliar academic and cultural environment [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. While young adults are particularly vulnerable to the adverse effects of loneliness [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], evidence consistently shows that positive interpersonal interactions, supportive relationships, and a strong sense of belonging are associated with reduced levels of stress, anxiety, and depressive symptoms [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. These findings highlight the critical role of in-person social connectedness as a key determinant of well-being, particularly within university settings [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eHowever, in recent years, also the rapid expansion of digital communication, mainly social media, has significantly reshaped social interactions, with both opportunities and challenges for students\u0026rsquo; psychological well-being and academic performance [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Social media, broadly defined as websites and applications that enable users to create and share content or to participate in social networking, can foster students\u0026rsquo; sense of belonging by facilitating connections with pre-existing support networks, and enabling new friendships [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. In addition, they provide a suitable space for self-disclosure and help-seeking within virtual communities [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. However, research has shown that spending more time online is associated with self-isolation, and the persistent comparison with peers through social content can exacerbate feelings of exclusion and inadequacy, leading to anxiety and depressive symptoms [\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Indeed, the psychological effects of social media seem to be influenced by the patterns of user engagement, with findings supporting a wide range of both positive and negative impacts on feelings of loneliness [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Although loneliness has been consistently associated with anxiety and depression, the potential mediating role of both online and in-person social connectedness on this relationship has not been fully explored yet [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. In particular, it can be argued that both virtual and in-person social interactions could partially mediate the relationship between loneliness and students\u0026rsquo; mental health and might represent potential targets for intervention. Thus, benefiting from data of cross-sectional study using a large and representative sample of university students from Italy and the UK, we tested the hypotheses that: (i) loneliness, social media use, and the frequency of in-person social interactions would be associated with anxiety and depressive symptoms; and (ii) the relationship between loneliness and these symptoms would be at least partially moderated by patterns of social media use and face-to-face interactions.\u003c/p\u003e"},{"header":"2. Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1. Study design and setting\u003c/h2\u003e\u003cp\u003eThis study followed the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) checklist [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Data were from the second wave of the \u0026ldquo;Caring and Assessing Mental health of student Populations at Unimib and uniSurrey (CAMPUS) study\u0026rdquo;, a large survey, longitudinally assessing the mental health of university students enrolled at the University of Milano-Bicocca (Unimib, Italy) and the University of Surrey (UoS, UK). The second wave was selected since it offered the most recent and comprehensive dataset available at the time of analysis. An online survey was delivered by e-mail to students between October and November 2022. The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2025. All procedures involving human subjects were approved by the Ethics Committees of the University of Milano-Bicocca (registration number: 0058642/21) and of the University of Surrey (registration number: FHMS 20\u0026ndash;21 157). Students older than 18 provided their informed consent online. They could complete the survey in a private setting and quit at any time. The online platform (Qualtrics) anonymously tracked both complete and partial responses.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.2. Measures\u003c/h2\u003e\u003cp\u003eAn extensive battery of instruments was used to gather information on both individual characteristics and psychometric measures, though only those relevant to this study are presented here.\u003c/p\u003e\u003cdiv id=\"Sec5\" class=\"Section3\"\u003e\u003ch2\u003e2.2.1. Participant Information\u003c/h2\u003e\u003cp\u003eWe collected information on age, gender, living conditions, and employment status. Data on the degree course, the years of study completed, as well as on the international background were also gathered. In-person social connectedness was assessed based on the frequency of interactions \u0026mdash;categorized as daily/weekly versus monthly or less frequent \u0026mdash; with relatives, friends, and classmates. Virtual social interactions were assessed based on the number of hours per day spent on social media and the type of platforms used.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section3\"\u003e\u003ch2\u003e2.2.2. Clinical Measures\u003c/h2\u003e\u003cp\u003eSelf-report psychometric measures included the 7-item General Anxiety Disorder scale (GAD-7), the 9-item Patient Health Questionnaire (PHQ-9), and the 7-item Insomnia Severity Index (ISI).\u003c/p\u003e\u003cp\u003eThe 7-item General Anxiety Disorder scale (GAD-7) was used to assess symptoms of generalized anxiety experienced in the previous two weeks. Response options include \u0026ldquo;never\u0026rdquo;, \u0026ldquo;some days\u0026rdquo;, \u0026ldquo;more than half the days\u0026rdquo;, and \u0026ldquo;almost every day\u0026rdquo;, with scores of 0, 1, 2 and 3, respectively, with the relevant total score for the seven items ranging from 0 to 21, and cut-offs as follows: 0\u0026ndash;4 minimal, 5\u0026ndash;9 mild, 10\u0026ndash;14 moderate, and 15\u0026ndash;21 severe anxiety [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAs far as depressive symptoms assessment, we used the 9-item Patient Health Questionnaire (PHQ-9) [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], the self-administered version of the Primary Care Evaluation of Mental Disorders (PRIME-MD) [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. The PHQ-9 enables screening, diagnosis, and severity assessment through nine items that reflect the symptoms of major depression according to DSM-IV over the previous two weeks. Possible answers include \u0026ldquo;never\u0026rdquo;, \u0026ldquo;several days\u0026rdquo;, \u0026ldquo;more than half the days\u0026rdquo;, and \u0026ldquo;nearly every day\u0026rdquo; and each item is rated from 0 (\u0026ldquo;never\u0026rdquo;) to 3 (\u0026ldquo;nearly every day\u0026rdquo;). The total score ranges from 0 to 27, according to these cut-offs: 5\u0026ndash;9 mild, 10\u0026ndash;14 moderate, 15\u0026ndash;19 moderately severe, and \u0026ge;\u0026thinsp;20 severe depressive symptoms [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe Insomnia Severity Index (ISI) is a self-report questionnaire designed to assess the severity of insomnia. It consists of seven items, each rated on a 5-point Likert scale, with total scores ranging from 0 to 28 and cut-offs as follows: 8\u0026ndash;14 subthreshold, 15\u0026ndash;21 moderate, and 22\u0026ndash;28 severe insomnia [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec7\" class=\"Section3\"\u003e\u003ch2\u003e2.2.3. Loneliness\u003c/h2\u003e\u003cp\u003ePerceived loneliness was assessed through the UCLA Loneliness Scale (Version 3), which consists of 20 items, each rated on a 4-point Likert scale, covering various aspects of social and emotional loneliness, according to these cut-offs: 20\u0026ndash;34 low, 35\u0026ndash;49 moderate, 50\u0026ndash;64 moderately high, and 65\u0026ndash;80 high degree of loneliness [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003e2.3. Statistics\u003c/h2\u003e\u003cp\u003eStatistical analyses were run using Stata (version 18, StataCorp. 2021. Stata Statistical Software, College Station, TX, USA). After performing validity and consistency checks of collected data, descriptive analyses were carried out to summarize characteristics of survey participants. In addition, we dealt with missing data issues, verifying that information on anxiety symptoms was not available when participants were early quitters (i.e., unanswered items\u0026thinsp;\u0026gt;\u0026thinsp;30%). We compared students who completed the survey to early quitters in order to identify characteristics potentially accounting for differences in the likelihood to complete the survey. Therefore, assuming that non-response depends at most on covariates, we ruled out a missing not at random (MNAR) condition. Standard statistics were provided for both continuous and categorical variables, stratifying by UCLA Loneliness scale cut-offs. Potential differences in perceived loneliness were thus assessed across individual characteristics by both running Pearson\u0026rsquo;s chi-square and Fisher\u0026rsquo;s exact tests for categorical variables and performing parametric (e.g., Student\u0026rsquo;s t test, analysis of variance) or non-parametric (e.g., Wilcoxon-Mann-Whitney test) analyses for continuous variables according to potential deviations of relevant assumptions (e.g., normally distributed residuals). Then, we carried out an ordered logistic regression and tested the potential moderating impact of social media use and the frequency of in-person social contacts on the interaction of loneliness categorized according to UCLA Loneliness Scale cut-offs (independent variable) and anxiety and depressive symptoms (dependent variable). Therefore, main effects and interaction terms were estimated. Each factor was entered in separate models to assess the individual impact on this relationship, and the potential effect between loneliness, anxiety and depressive symptoms was estimated considering time on social media and the frequency of in-person social interactions strata. All models were adjusted for gender, age, and insomnia symptoms, potentially accounting for differences. In addition, we allowed for intragroup correlation, considering that observations may not be independent within site (Italy vs. UK) groups. Regression coefficients with 95% Confidence Intervals (95%CI) and Standard Errors (SE) were reported. Statistical significance was set at a p-value of 0.05.\u003c/p\u003e\u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\n\u003ch2\u003e3.1. Sample Characteristics\u003c/h2\u003e\n\u003cp\u003eThe online survey was delivered to all university students older than 18, gathering a total of 2,979 responses. As a whole, 69% of the sample reported information on anxiety symptoms. Therefore, the final sample comprised 2,055 undergraduate students from Italy and the UK, including (21.5%) men and (75.4%) women with a mean age (standard deviation, SD) of 22.77 (5.21) years. Most students (71.2%) were attending the first two years of their academic career, mainly from Psychosocial Sciences (703/34.2%), Medical Sciences (517/25.2%), and Applied/Natural Sciences (456/22.2%) programmes. Overall, 1,038 participants (50.5%) reported spending between one and three hours per day on social media. In addition, half of the sample used more than one social platform, with Instagram\u0026reg; being the most popular (1,620/78.9%), followed by TikTok\u0026reg; (768/37.4%). Finally, 1,410 (68.6%) students reported having near-daily in-person interactions with relatives and 646 (31.4%) with friends. As compared to students who quitted the survey early and did not report information on anxiety symptoms, but only sociodemographic data (N\u0026thinsp;=\u0026thinsp;369), survey completers (N\u0026thinsp;=\u0026thinsp;2,055) were more likely to be younger [22.76 (SD\u0026thinsp;=\u0026thinsp;5.21) vs. 23.80 (SD\u0026thinsp;=\u0026thinsp;5.40); p\u0026thinsp;\u0026lt;\u0026thinsp;0.001], and to be from the UK (34.21% vs. 20.33%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Descriptive statistics for the overall sample of students who completed the survey are presented in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e, with country-specific data detailed in \u003cstrong\u003eSupplementary Table\u0026nbsp;1\u003c/strong\u003e.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eSociodemographic and clinical characteristics by level of perceived loneliness assessed by UCLA Loneliness Scale (Version 3).\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eCharacteristics\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eOverall\u003c/p\u003e\n\u003cp\u003esample\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003eUCLA**\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003ep-value*\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eN\u0026thinsp;=\u0026thinsp;2,055\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eLow\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eModerate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eN (%) or Mean (SD)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eModerately high\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eHigh\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eN (%) or Mean (SD)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eN (%) or Mean (SD)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eN (%) or Mean (SD)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eN (%) or Mean (SD)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWomen\u003c/p\u003e\n\u003cp\u003eMen\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1,550 (75.4%)\u003c/p\u003e\n\u003cp\u003e442 (21.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e219 (14.2%)\u003c/p\u003e\n\u003cp\u003e55 (12.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e494 (31.9%)\u003c/p\u003e\n\u003cp\u003e134 (30.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e533 (34.4%)\u003c/p\u003e\n\u003cp\u003e170 (38.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e136 (8.8%)\u003c/p\u003e\n\u003cp\u003e38 (8.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.46\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e, \u003cem\u003eyrs.\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e22.77 (5.21)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e23.75 (6.22)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e22.99 (5.81)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e22.45 (4.37)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e22.16 (3.57)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.08\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eYears of study\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFirst\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e664 (32.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e85 (12.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e182 (27.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e257 (38.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e69 (10.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ep\u0026thinsp;=\u0026thinsp;0.002\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSecond\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e634 (38.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e83 (13.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e228 (36%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e204 (32.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e58 (9.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eThird\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e445 (21.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e48 (10.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e144 (32.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e163 (36.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e39 (8.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFourth\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e119 (5.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e22 (18.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e38 (32%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e35 (29.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11 (9.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFifth - Sixth\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e126 (6.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e26 (20.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e35 (27.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e49 (38.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8 (6.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eDegree Programme Area\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eApplied/Natural Sciences\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e456 (22.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e51 (11.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e125 (27.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e175 (38.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e59 (12.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ep\u0026thinsp;=\u0026thinsp;0.002\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eEconomic/Legal Sciences\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e343 (16.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e40 (11.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e109 (31.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e118 (34.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e23 (6.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMedical Sciences\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e517 (25.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e83 (16.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e152 (29.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e187 (36.17%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e41 (7.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePsychosocial Sciences\u003csup\u003e4\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e703 (34.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e101 (14.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e245 (34.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e238 (33.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e60 (8.53%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eInternational student\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e103 (5.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12 (11.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e34 (33.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e36 (35.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9 (8.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.94\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eOut-of-town student\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e686 (33.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e92 (13.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e225(32.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e244 (35.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e65 (9.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.92\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eEmployment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNon-worker\u003c/p\u003e\n\u003cp\u003ePart-time or full-time worker\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e683 (33.2%)\u003c/p\u003e\n\u003cp\u003e1,332 (64.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e87 (12.7%)\u003c/p\u003e\n\u003cp\u003e189 (14.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e208 (30.5%)\u003c/p\u003e\n\u003cp\u003e425 (32.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e246 (36.0%)\u003c/p\u003e\n\u003cp\u003e465 (35.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e70 (10.3%)\u003c/p\u003e\n\u003cp\u003e115 (8.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.49\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSingle\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1,047 (51.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e108 (10.32%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e309 (29.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e397 (37.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e114 (10.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIn a committed relationship\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e945 (46.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e162 (17.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e320 (33.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e309 (32.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e63 (6.70%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eAccommodation\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eWith family of origin\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1,071 (52.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e133 (12.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e344 (32.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e389 (36.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e102 (9.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eOn campus\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e302 (14.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e43 (14.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e86 (28.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e101 (33.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e31 (10.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eWith roommates outside campus\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e375 (18.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e50 (13.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e131(35.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e134 (35.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e20 (5.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eWith partner\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e164 (8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e34 (20.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e48 (29.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e55 (33.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9 (5.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAlone\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e103 (5.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11 (10.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e25 (24.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e38 (36.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e20 (19.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eOn track with exams\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1,298 (63.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e206 (15.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e438 (33.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e427 (32.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e96 (7.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eSocial interactions \u0026ndash; family\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDaily/more time a week\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1,410 (68.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e182 (13%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e436 (30.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e515 (36.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e131 (9.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.12\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eWeekly\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e251 (12.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e49 (19.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e77 (30.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e79 (31.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e21 (8.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMonthly or less\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e349 (17.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e44 (12.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e119 (34.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e117 (33.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e31 (8.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eSocial interactions \u0026ndash; partner\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDaily/more time a week\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e616 (30.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e104 (16.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e208 (33.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e206 (33.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e38 (6.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ep\u0026thinsp;=\u0026thinsp;0.033\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eWeekly\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e152 (7.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e27 (17.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e55 (36.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e37 (24.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e20 (13.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMonthly or less\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e287 (14%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e50 (17.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e87 (30.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e101 (35.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18 (6.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eSocial interactions \u0026ndash; friends\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDaily/more time a week\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e646 (31.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e110 (17.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e221 (34.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e203 (31.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e49 (7.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eWeekly\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e689 (33.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e69 (10.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e222 (32.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e268 (38.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e59 (8.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMonthly or less\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e693 (33.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e99 (14.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e198 (28.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e249 (35.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e72 (10.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eSocial interactions \u0026ndash; classmates\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDaily/more time a week\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e901 (43.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e122 (13.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e306 (34%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e311 (34.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e71 (7.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.39\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eWeekly\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e233 (11.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e28 (12%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e79 (33.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e80 (34.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e25 (10.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMonthly or less\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e801 (39.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e118 (14.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e134 (16.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e286 (35.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e72 (9.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eTime spent on social media\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;1 hrs.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e262 (12.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e42 (16.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e89 (34.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e80 (30.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e29 (11.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ep\u0026thinsp;=\u0026thinsp;0.005\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFrom 1 to 3 hrs.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1,038 (50.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e160 (15.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e324 (32.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e364 (35.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e82 (7.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFrom 3 to 5 hrs.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e552 (26.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e58 (10.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e180 (32.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e195 (35.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e50 (9.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026gt;\u0026thinsp;5 hrs.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e180 (8.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e17 (9.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e45 (25.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e82 (45.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e24 (13.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eNumber of social media platforms\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e997 (48.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e132 (13.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e313 (31.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e351 (35.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e97 (9.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.79\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e798 (38.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e114 (14.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e260 (32.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e275 (34.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e66 (8.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e227 (11.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e31 (13.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e61 (26.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e90 (39.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e21 (9.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026ge;\u0026thinsp;4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e33 (1.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2 (6.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11 (33.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13 (39.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3 (9.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eAnxiety symptoms (GAD-7)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9.38 (5.32)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5.77 (4.29)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8.07 (4.50)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10.79 (5.16)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13.76 (9.38)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eDepressive symptoms (PHQ-9)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9.83 (6.21)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5.05 (4.23)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7.11 (5.04)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11.64 (5.75)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e16.24 (6.10)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eInsomnia symptoms (ISI)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9.06 (5.21)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6.35 (4.13)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8.36 (4.78)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10.05 (5.22)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11.66 (5.77)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e* Statistically significant differences between groups defined by the UCLA Loneliness Scale (Version 3) cut-offs (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\n\u003cp\u003e** Data for the UCLA Loneliness Scale (Version 3) was available for 1,841 (90%) participants.\u003c/p\u003e\n\u003cp\u003eMissing values are not reported in the table.\u003c/p\u003e\n\u003cp\u003eSD: Standard deviation.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003eApplied/Natural Sciences: Biochemistry; Biology; Biomedical Engineering; Biomedical Sciences; Computer Sciences; Geology; Maths.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e2\u003c/sup\u003eEconomic/Legal Sciences: Economics; Hospitality and Tourism; Law; Politics.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e3\u003c/sup\u003eMedical sciences: Medicine and Surgery; Nursing; Nutrition; Paramedics; Veterinary Medicine.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e4\u003c/sup\u003ePsychosocial sciences: Education Sciences; Intercultural Communication; Psychology; Sociology\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n\u003ch2\u003e3.2. Clinical assessment, in-person social interactions and social media use\u003c/h2\u003e\n\u003cp\u003eThe mean UCLA loneliness score for the overall sample was 48.78 (SD\u0026thinsp;=\u0026thinsp;12.31). Compared to individuals with low loneliness, those with moderate loneliness reported significantly higher anxiety (coeff.=1.03, 95%CI 0.79; 1.26, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and depressive symptoms (coeff.=1.25, 95%CI 0.83; 1.66, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). This association was even more marked for individuals with moderately high to high loneliness levels (anxiety: coeff.=2.15, 95%CI 2.03; 2.28, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001; depressive symptoms: coeff.=2.65, 95%CI 2.29; 3.01, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), as compared to those with lower total scores at UCLA. In addition, students who reported interacting with friends almost daily had a mean UCLA score of 46.97 (SD\u0026thinsp;=\u0026thinsp;12.32), significantly lower (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) as compared with those with less frequent social connections [49.16 (SD\u0026thinsp;=\u0026thinsp;12.80)]. Conversely, participants who used social media for less than 3 hours per day reported a mean UCLA score of 47.96 (SD\u0026thinsp;=\u0026thinsp;12.43), whereas those daily using them for 3 or more hours had a higher mean score [50.22 (SD\u0026thinsp;=\u0026thinsp;11.96)] (p\u0026thinsp;=\u0026thinsp;0.005). The mean score for anxiety symptoms, as measured by the GAD-7, was 9.38 (SD\u0026thinsp;=\u0026thinsp;5.32). Students who more frequently interacted with friends reported a higher mean GAD-7 score (mean\u0026thinsp;=\u0026thinsp;9.62, SD\u0026thinsp;=\u0026thinsp;5.21) as compared to the comparison group (mean\u0026thinsp;=\u0026thinsp;9.04, SD\u0026thinsp;=\u0026thinsp;5.79) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Furthermore, students who reported daily use of social media for less than 3 hours had a significantly lower mean GAD-7 score (mean\u0026thinsp;=\u0026thinsp;8.91, SD\u0026thinsp;=\u0026thinsp;5.09) compared to those who used them\u0026thinsp;\u0026ge;\u0026thinsp;3h/day (mean\u0026thinsp;=\u0026thinsp;10.11, SD\u0026thinsp;=\u0026thinsp;5.62) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The average score for depressive symptoms, as assessed by PHQ-9, was 9.83 (SD\u0026thinsp;=\u0026thinsp;6.21). Participants who spent\u0026thinsp;\u0026ge;\u0026thinsp;3h/day on social media reported higher levels of depressive symptoms (mean\u0026thinsp;=\u0026thinsp;11.30, SD\u0026thinsp;=\u0026thinsp;6.24) compared to those with less frequent use (mean\u0026thinsp;=\u0026thinsp;9.01, SD\u0026thinsp;=\u0026thinsp;6.03) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Relevant associations for the overall sample and by UCLA levels are presented in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\n\u003cdiv id=\"Sec12\" class=\"Section3\"\u003e\n\u003ch2\u003e3.2.1 Effect of in-person and virtual social interactions on the relationship between loneliness and anxiety symptoms.\u003c/h2\u003e\n\u003cp\u003eBuilding on the observation that the estimated effects of loneliness on GAD-7 and PHQ-9 total scores varied according to the frequency of contact with friends and the amount of time spent on social media, we explored potential interaction effects between these variables. Therefore, after controlling for gender, age, and insomnia symptoms, we tested whether frequency of interactions with friends and social media use would moderate the relationship between loneliness (categorized as moderately and moderately/high vs. low for analytical purposes) and anxiety symptoms. (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003ea) A statistically significant main effect of perceived loneliness on anxiety symptoms was observed (moderate loneliness: coeff.=0.84, 95%CI 0.81; 0.88, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001; moderately high/high loneliness: coeff.=2.20, 95%CI 1.90, 2.49, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Moreover, a significant effect of in-person interactions on the relationship between loneliness and anxiety symptoms was found. Specifically, among individuals reporting moderate loneliness, more frequent social interaction with friends was significantly associated with higher GAD-7 scores (coeff.=0.21, 95%CI 0.15; 0.27, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). On the contrary, students with moderately high/high UCLA loneliness scores who interacted with friends multiple times a week or daily showed a significant association with lower level of anxiety (coeff.=-0.36, 95%CI -0.44; -0.27, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). No significant contribution of social media use to the model was found (p\u0026thinsp;=\u0026thinsp;0.47). The moderation models are shown in Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003ea.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003e\u003cstrong\u003ea/2b.\u003c/strong\u003e Ordered logistic regression assessing the influence of in-person social interactions and social media use on the relationship between loneliness and anxiety and depressive symptoms.\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e2a. Anxiety symptoms (GAD-7)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eCoefficient\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eStandard error\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e95%CI\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ep-value\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eLoneliness (UCLA) \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003emoderate\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.84\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.02\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.81; 0.88\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003emoderately-high/high\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.20\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.15\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.90; 2.49\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eIn-person interactions\u003c/strong\u003e \u003csup\u003e\u003cstrong\u003eb\u003c/strong\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eweekly\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.54\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.32; 0.75\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003edaily/multiple times a week\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.65\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.09\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.49; 0.82\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eSocial media use\u003c/strong\u003e \u003csup\u003e\u003cstrong\u003ec\u003c/strong\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026ge;\u0026thinsp;3h/day\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.03\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.36\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.67; 0.73\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.93\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.02\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.03; -0.02\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eFemale sex\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.75\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.02\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.70; 0.79\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eISI total score\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.01\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.10; 0.14\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eLoneliness (UCLA)\u003c/strong\u003e \u003csup\u003e\u003cstrong\u003ea\u003c/strong\u003e\u003c/sup\u003e \u003cstrong\u003e\u0026times; in-person interactions\u003c/strong\u003e \u003csup\u003e\u003cstrong\u003eb\u003c/strong\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003emoderate\u003c/em\u003e \u003cstrong\u003e\u0026times;\u003c/strong\u003e \u003cem\u003eweekly\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.25\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.48\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.35; -0.16\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003emoderate\u003c/em\u003e \u003cstrong\u003e\u0026times;\u003c/strong\u003e \u003cem\u003edaily/multiple times a week\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.21\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.03\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.15, 0.27\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003emoderately-high/high\u003c/em\u003e \u003cstrong\u003e\u0026times;\u003c/strong\u003e \u003cem\u003eweekly\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.50\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.03\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.56; -0.44\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003emoderately-high/high\u003c/em\u003e \u003cstrong\u003e\u0026times;\u003c/strong\u003e \u003cem\u003edaily/multiple times a week\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.36\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.04\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.44; -0.27\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e2b. Depressive symptoms (PHQ-9)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eCoefficient\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eStandard error\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e95%CI\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eLoneliness (UCLA)\u003c/strong\u003e \u003csup\u003e\u003cstrong\u003ea\u003c/strong\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003emoderate\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.08\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.85; 1.15\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003emoderately-high/high\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.40\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.16, 2.63\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eIn-person interactions\u003c/strong\u003e \u003csup\u003e\u003cstrong\u003eb\u003c/strong\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eweekly\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.08\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.06\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.12; 0.31\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.18\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003edaily/multiple times a week\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.21\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.12; 0.20\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.56\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eSocial media use\u003c/strong\u003e \u003csup\u003e\u003cstrong\u003ec\u003c/strong\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026ge;\u0026thinsp;3h/day\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.17\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.15\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.13; -0.47\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.27\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.04\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.05; -0.03\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eFemale sex\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.43\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.01\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.40; 0.45\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eISI total score\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.21\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.01\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.20; 0.22\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eLoneliness (UCLA)\u003c/strong\u003e \u003csup\u003e\u003cstrong\u003ea\u003c/strong\u003e\u003c/sup\u003e \u003cstrong\u003e\u0026times;\u003c/strong\u003e \u003cstrong\u003ein-person interactions\u003c/strong\u003e \u003csup\u003e\u003cstrong\u003eb\u003c/strong\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003emoderate\u003c/em\u003e \u003cstrong\u003e\u0026times;\u003c/strong\u003e \u003cem\u003eweekly\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.07\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.29; 0.14\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.50\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003emoderate\u003c/em\u003e \u003cstrong\u003e\u0026times;\u003c/strong\u003e \u003cem\u003edaily/multiple times a week\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.06\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.22\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.49; 0.38\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.79\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003emoderately-high/high\u003c/em\u003e \u003cstrong\u003e\u0026times;\u003c/strong\u003e \u003cem\u003eweekly\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.25\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.45; -0.05\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ep\u0026thinsp;=\u0026thinsp;0.016\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003emoderately-high/high \u0026times; daily/multiple times a week\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.19\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.27\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.07; 0.33\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.47\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eLoneliness (UCLA)\u003c/strong\u003e \u003csup\u003e\u003cstrong\u003ea\u003c/strong\u003e\u003c/sup\u003e \u003cstrong\u003e\u0026times; social media use\u003c/strong\u003e \u003csup\u003e\u003cstrong\u003ec\u003c/strong\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003emoderate\u003c/em\u003e \u003cstrong\u003e\u0026times;\u003c/strong\u003e \u003cem\u003e\u0026ge;3h/day\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.21\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.05\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.12; 0.31\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003emoderately-high/ high\u003c/em\u003e \u003cstrong\u003e\u0026times;\u003c/strong\u003e \u003cem\u003e\u0026ge;3h/day\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.16\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.02\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.12; 0.20\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"5\"\u003eN\u0026thinsp;=\u0026thinsp;1,793\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e3.2.2 Effect of in-person and virtual social interactions on the relationship between loneliness and depressive symptoms. \u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eControlling for the same variables, we tested the moderating effect of in-person and online social interactions on the relationship between loneliness and depressive symptoms (\u003cstrong\u003eTable 2b\u003c/strong\u003e). Based on UCLA scores categorized as moderately and moderately/high vs. low for analytical purposes, a statistically significant effect of loneliness on the likelihood of higher PHQ-9 scores was detected (moderate loneliness: coeff.=1.25, 95%CI 0.83; 1.66, p\u0026lt;0.001; moderately high/high loneliness: coeff.=2.65, 95%CI 2.29; 3.01, p\u0026lt;0.001). In addition, in-person interactions showed a potential mediating role on the relationship between loneliness and depressive symptoms. Specifically, among individuals reporting moderately high/high loneliness, more frequent social interactions with friends were significantly associated with lower PHQ-9 scores (coeff.=-0.25; 95%CI -0.45; -0.05, p=0.016). Finally, a significant effect of the use of social media on the relationship between loneliness and depressive symptoms was found. Indeed, among individuals reporting moderate loneliness, more intense use of social media was significantly associated with higher PHQ-9 scores (coeff.=0.21, 95%CI 0.12; 0.31, p\u0026lt;0.001). Similarly, students with moderately high/high UCLA loneliness scores who use social media \u0026ge;3 hours/day showed a significant association with higher PHQ-scores (coeff.=0.16, 95%CI 0.12; 0.20, p\u0026lt;0.001).The moderation models are shown in \u003cstrong\u003eFigure 1b\u003c/strong\u003e.\u003c/p\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eTo our knowledge, this is the first study investigating whether in-person or virtual social interactions can influence the relationship between loneliness and anxiety and depressive symptoms among university students.\u0026nbsp;We consistently observed distinct associations between loneliness, in-person and online social interactions, and symptoms of anxiety and depression. In addition, both in-person and online social connections exerted a moderating effect on the relationship between loneliness and anxiety and depressive symptoms. Our findings are consistent \u0026nbsp;with prior research showing a positive association between loneliness and both anxiety and depressive symptoms from both cross-sectional[16,17] and longitudinal research[24].Evidence also suggests a bidirectional relationship, where loneliness and depression mutually reinforce one another over time[24]. Similarly, anxiety has been found to predict future experiences of loneliness across age groups, following a reciprocal trajectory[4,25]. Loneliness has also been identified as a mediator in the relationship between anxiety and depression and is closely linked to social anxiety, both in youth and older adults[26].Shared features, such as social withdrawal, negative social cognition, impaired interpersonal functioning, and reduced quality of social interactions, may underlie and intensify the experience of loneliness [25]. Moreover, previous research has shown that supportive relationships and positive in-person interactions are associated with lower levels of loneliness in young adults [5,27], thus reinforcing the importance of social connectedness for students’ well-being [6]. Although anxiety is often linked to social withdrawal[4,5], some individuals with higher levels of generalized anxiety may actually seek out more frequent social interactions with peers as a coping mechanism or a strategy for emotional regulation[28]. In this light, social buffering may reflect an adaptive or compensatory behaviour in response to elevated anxiety levels, as well as a desire for reassurance, validation, or distraction from anxious thoughts[29,30]. On the contrary, a greater number of superficial relationships may heighten psychological distress by intensifying feelings of exclusion and inadequacy, ultimately contributing to increased anxiety [11,12,27]. Similarly, the impact of social media on mental health appears to be multifactorial, with excessive use or passive consumption potentially linked to increased feelings of isolation, unworthiness, and psychological distress[14,15,31].However, our study also reveals a partial moderating effect of in-person social interactions on the relationship between loneliness and both anxiety and depressive symptoms, as well as a partial moderating role of social media use in the relationship between UCLA scores and depressive symptoms. Notably, students with moderate levels of loneliness who engaged in frequent face-to-face interactions reported higher anxiety. Conversely, among students experiencing higher loneliness, frequent in-person interactions were associated with lower depressive symptoms and anxiety scores, suggesting a potential protective effect. This complexity underscores the importance of the quality rather than just the frequency of social contacts[32].The university environment, with its social demands, performance pressures, and need for integration, can heighten anxiety in vulnerable students, potentially creating a feedback loop in which social efforts increase psychological distress[33].This suggests that the impact of social interactions on mental health may depend on a student’s baseline level of loneliness and the specific features of social relationships [2,34]. Consistently, our results show that more frequent in-person contact can mitigate depressive symptoms in highly lonely students, highlighting the importance of emotional support and meaningful interpersonal exchanges in reducing psychological distress [5]. Indeed, evidence consistently shows that positive interpersonal interactions, supportive relationships, and a strong sense of belonging are associated with reduced levels of stress and depressive symptoms[5]. In contrast, we found that more frequent online interactions were associated with higher depression levels in students experiencing both moderate and high levels of loneliness.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSeveral mechanisms may underlie this pattern [35]. First, increased social media use may displace real-life interactions, exacerbating pre-existing loneliness[35].The nature of online engagement could also play a crucial role, since the association between loneliness and poor mental health outcomes seem to be stronger in individuals with more frequent social media engagement[36].For students already feeling lonely, virtual interactions may fail to provide meaningful connection and instead worsen psychological vulnerability, creating a negative cycle where increased social media use deepens isolation and distress [11,12]. Superficial exchanges, or even negative experiences such as cyberbullying, may further compound feelings of isolation[11,12].\u003c/p\u003e\n\u003cp\u003eUnderstanding the role of cultural and lifestyle differences among students is also essential in interpreting our findings. For instance, UK students often live on campus or in shared accommodation [37],which may enhance peer interaction but also introduce new responsibilities and stressors linked to poorer mental health[38].Limited family contact, increased autonomy, and different lifestyle habits can contribute to elevated rates of depressive symptoms[39]. On the other hand, communal living may foster social engagement with peers[40].In contrast, most Italian students reside with their families[41], which may limit peer bonding opportunities and contribute to higher levels of social isolation and anxiety[5,34].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOverall, our findings highlight that the transition to university is a complex, multidimensional process that extends beyond academic adaptation to include crucial social components. Institutional support, such as orientation programs, peer mentoring, and community-building initiatives, plays a key role in facilitating this transition[42].Given the strong interplay between loneliness, social interaction, and mental health, interventions should focus on fostering social connectedness as a core element in both the prevention of loneliness and the promotion of mental well-being[43]. Creating opportunities for meaningful in-person interactions and group cohesion is just as important as encouraging a mindful and balanced approach to online engagement[44].\u003csup\u003e.\u0026nbsp;\u003c/sup\u003eIn this context, social skills counselling may be especially beneficial for students experiencing loneliness, equipping them with tools to build and maintain supportive relationships[42,45]. Likewise, mental health interventions in the digital age should promote balanced use of online platforms, encourage critical consumption of digital content, and facilitate emotionally meaningful virtual interactions to counteract the potential negative effects of social media on well-being[8,44].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eLimitations\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eOur findings should be interpreted with caution considering some methodological limitations. First, the cross-sectional nature of the study does not allow us to draw conclusions on causal relationships between perceived loneliness, the dependent variables and any moderating factors. Consistently, different directional paths might underlie these relationships. Secondly, in-person and virtual social interactions were evaluated using approximate proxy measures, based on self-reported frequency of interactions with family members, peers, and classmates, as well as levels of engagement with social media platforms. We therefore only investigated the quantity, but not the quality, of social interactions. Future studies should incorporate more refined measures, such as assessments of social support, relationship quality, and the specific types of online and offline interactions, to provide a richer understanding of their impact on loneliness. Third, since clinical domains were measured by brief screening scales, future research would benefit from more comprehensive and structured diagnostic reporting of clinical conditions, in order to reduce recall bias and/or under-reporting, as well as potential misclassification. Furthermore, our methodology, reliant on an online survey for clinical data collection, inherently presents various limitations, notably concerning sampling issues [46]. Similarly, the selected participants may not entirely reflect the broader university student population. They are likely to be individuals already interested in mental health issues, potentially involving a selection bias. However, the survey was conducted within a private household setting, which has been shown to mitigate under-reporting and bias, facilitated by perceived privacy and anonymity, thereby addressing potential stigmatization or embarrassment [47]. \u0026nbsp;\u003c/p\u003e"},{"header":"5. Conclusions ","content":"\u003cp\u003eOur study confirms the well-established link between perceived loneliness and anxiety and depressive symptoms. In-person social connectedness seems a significant mediator for both these outcomes among university students, while social media use seems to play a significant role in the relationship between loneliness and depressive symptoms. Interventions aimed at enhancing both the quantity and quality of in-person and virtual social interactions may be beneficial for students experiencing loneliness and associated clinical conditions.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eUK\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eUnited Kingdom\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eUnimib\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eUniversity of Milano-Bicocca\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eUoS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eUniversity of Surrey\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eGAD-7\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eGeneralized Anxiety Disorder scale-7\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003ePHQ-9\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ePatient Health Questionnaire-9\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eISI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eInsomnia Severity Index\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eUCLA\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eUcla Loneliness Scale (Version 3)\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSD\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eStandard Deviation.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics Approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in accordance with the Declaration of Helsinki, and approved by the Ethics Committee of University of Milano-Bicocca (protocol code 0058642/21; 19 March 2021) and of the University of Surrey (registration number: FHMS 20-21 157; 21 July 2021).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all subjects involved in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no specific grant from any funding agency, commercial or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization, I.R., C.C.; Methodology, I.R., C.C.; Validation, I.R., C.C.; Formal Analysis, I.R., C.C.; Investigation, I.R., C.A.C.; Resources, I.R., C.T. and J.A; Data Curation, I.R., C.A.C.; Writing—Original Draft Preparation, I.R.; Writing—Review \u0026amp; Editing, I.R., C.C., G.C., and F.B. Visualization, C.C., F.B. and G.C.; Supervision, C.T., J.A. and G.C.; Project Administration, C.T., J.A. and G.C. All authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank all the students who took part in the survey. We also thank the University Steering Committee for supporting and promoting the project, as well as the Programmes' Leaders from UoS, and the students' representatives from Unimib and UoS.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSheldon E, Simmonds-Buckley M, Bone C, Mascarenhas T, Chan N, Wincott M, Gleeson H, Sow K, Hind D, Barkham M. Prevalence and risk factors for mental health problems in university undergraduate students: A systematic review with meta-analysis. 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Addict Behav. 2017;73:133\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.addbeh.2017.05.005\u003c/span\u003e\u003cspan address=\"10.1016/j.addbeh.2017.05.005\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"psyo","sideBox":"Learn more about [BMC Psychology](http://bmcpsychology.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Psychology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"loneliness, mental health, social connectedness, social media, university students","lastPublishedDoi":"10.21203/rs.3.rs-6914480/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6914480/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e The transition to university can amplify students’ social isolation, leading to mental distress. In particular, loneliness could play a key role in the onset of anxiety and depressive symptoms. Different patterns of students’ social interactions, both in-person and online, may add complexity to the relationship between loneliness and mental health problems. Our study aimed to evaluatethe moderating role of both in-person and virtual social connectedness on the relationship between loneliness and anxiety or depressive symptoms.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod: \u003c/strong\u003eData were from the CAMPUS study (0058642/21; FHMS 20-21 157), a survey on university students’ mental health in Italy and the United Kingdom (UK). An ordered logistic regression was carried out to test the potential moderating effect of social media use and the frequency of in-person interactions on the relationship between loneliness (UCLA), anxiety (GAD-7), and depressive symptoms (PHQ-9).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e A significant positive association between perceived loneliness and both anxiety (p\u0026lt;0.001) and depressive symptoms (p\u0026lt;0.001) was found. However, in-person interactions significantly moderated this relationship for both anxiety, in a bidirectional way depending on the level of loneliness (p\u0026lt;0.001), and depressive symptoms (coeff.=-0.25, 95%CI -0.45;-0.05, p=0.016). Furthermore, social media use significantly influenced the relationship between loneliness and depressive symptoms (coeff.=0.21, 95%CI 0.12;0.31, p\u0026lt;0.001), but not the relationship between loneliness and anxiety symptoms (p=0.47).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e Along with the association between loneliness and anxiety or depressive symptoms, our findings highlight the key moderating role of both virtual and in-person social interactions, which may be targeted by tailored support, ultimately improving anxiety and depressive symptoms among university students.\u003c/p\u003e","manuscriptTitle":"Testing the moderating role of in-person and virtual social interactions among university students on the relationship between loneliness and anxiety or depressive symptoms","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-17 13:28:26","doi":"10.21203/rs.3.rs-6914480/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-07-21T13:20:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"168837782113777631522382840803987453282","date":"2025-07-15T12:05:33+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-15T07:40:54+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-06-23T14:05:45+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-19T00:35:46+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-19T00:34:45+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Psychology","date":"2025-06-17T12:35:52+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"psyo","sideBox":"Learn more about [BMC Psychology](http://bmcpsychology.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Psychology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"32f5bb18-cb95-4d11-b37c-b58cf1e98f88","owner":[],"postedDate":"July 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-07-17T13:28:26+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-17 13:28:26","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6914480","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6914480","identity":"rs-6914480","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}